Stephanie Wilcox has had eczema ever since she was a little girl. The bright-red rash came and went, but her skin condition really became a problem when she left Vancouver to go to university in France in her early 20s.
“I was really stressed out, and it came back,” Wilcox says in a phone interview. “It was super annoying. I had these terrible rashes all along my arms and around my eyes. People would think I was having the worst allergic reaction ever.”
Her eczema took more than a physical toll.
“I thought I was allergic to everything, and I started having anxiety attacks and I couldn’t sleep,” says Wilcox, now 29. “I wouldn’t go anywhere, and it was pretty much ruining my life.”
Once back on the West Coast, Wilcox experienced the same pattern: whenever she was feeling stressed, her eczema would flare up and she’d start feeling anxious as a result.
Eczema is a chronic, recurring inflammation of the skin that usually starts in early childhood. Also known as atopic eczema or atopic dermatitis, it’s intensely itchy and can appear anywhere on a person’s body.
It affects 15 to 20 percent of Canadians, according to the Eczema Society of Canada. It appears to be becoming more prevalent for reasons that are not well understood.
“It’s likely related to environmental factors,” says Dr. Jason Rivers, clinical professor of dermatology at UBC and medical director of Pacific Dermaesthetics, in a phone interview. “Stress can also play a role.”
There’s no test for the condition, but many people who suffer from it have elevated levels of immunoglobulin E, which is a sign of increased immunological activity. External factors often influence the condition, and colder temperatures can aggravate it. “It’s sometimes known as ”˜winter itch’,” Rivers says, noting that steroids are a “cornerstone” of treatment. These can be topical or oral corticosteroids, which reduce itching and inflammation. Topical immunomodulators are also used to decrease flare-ups.
Eczema’s trademark itchy, dry skin is caused by a dysfunctional skin barrier, which makes the skin hypersensitive to triggers like harsh soaps and perfumes and initiates inflammatory responses by the body. Frequent use of moisturizers—as often as four times a day—helps people manage eczema, as does frequent bathing.
“Moisturizing is critical for controlling people’s eczema,” Rivers says.
Light therapy is sometimes used in stubborn cases, while antihistamines can help relieve itching.
New research is looking into retinoids—synthetic derivatives of Vitamin A that are used to treat certain types of cancer, among other disorders—as well as immunosuppressant therapy to treat eczema. However, such treatments can have serious side effects and are costly.
Another approach addresses a person’s diet. A diet high in nickel—which is found in certain nuts, oats, peas, and dried fruit—for instance, is associated with the condition, Rivers notes.
Nari Pidutti, a naturopath at Vancouver’s Springs Eternal Natural Health Clinic, says many of her patients with eczema respond well to dietary modifications, specifically the elimination of certain allergens, such as dairy, wheat, and eggs.
She says it often helps to treat the “gut”, since skin conditions can be linked to dysbiosis, or microbial imbalances in the body.
“The aim is to balance and restore the normal flora,” Pidutti says in a phone interview. Some people find relief through treatments that control an overgrowth of a form of yeast, Candida albicans.
Reducing stress, she says, is crucial. Her clinic uses such mind-body approaches as the “emotional freedom” technique.
“It’s much more than skin-deep,” Pidutti says of eczema. In traditional Chinese medicine, she notes, the condition is viewed as a sign of too much “heat” in the system, so people are advised to add “heat clearing” foods such as watermelon and pineapple to their diet.
As Wilcox can attest, eczema is more than a mere skin problem: it can be a cause of psychological distress, because people are often embarrassed by the way they look.
“For some people, they cannot go out in public,” Rivers says. “My role as a dermatologist is to provide people with measures to treat skin so that they’re less socially inconvenienced.”
Feelings of shame can also accompany psoriasis, a skin condition that affects about three percent of the Canadian population, according to the Vancouver-based SkinCareGuide Web site. Psoriasis is a “T-cell-mediated” autoimmune disorder, T cells being white blood cells that regulate the body’s immune system. With psoriasis, T cells become overactivated, which triggers an inflammatory response in which the body accelerates the production of skin cells.
It normally takes about 28 days for the skin to complete a cycle of producing and shedding cells. With psoriasis, the process only takes about four days, resulting in poorly formed outer cells that don’t shed properly. Accumulated dead skin cells pile up and produce the associated thick, red patches of skin (called plaques) with silvery scales. Psoriasis can affect any part of the body, including the scalp, elbows, knees, lower back, and nails, but the face usually isn’t affected.
It’s not known what causes psoriasis, but autoimmune and genetic factors are involved. Stress, smoking, and alcohol appear to aggravate the condition. Certain medications can also exacerbate it, including antimalarials, lithium, beta blockers, and nonsteroidal anti-inflammatory drugs.
Five to 10 percent of people with the disorder go on to experience a disabling condition called psoriatic arthritis, which commonly affects the knees.
Pidutti says that psoriasis can be more difficult to treat than eczema, but that liver cleanses can be beneficial.
“It’s about decreasing the toxic load,” Pidutti says.
Conventional treatments of psoriasis include the use of nonsteroidal or steroidal creams, a coal-tar preparation, and the cancer drug methotrexate. Phototherapy is especially helpful and involves short courses of ultraviolet B rays or a mix of ultraviolet A rays and psoralen, a light-sensitizing medication.